Provider First Line Business Practice Location Address:
1460 N. 16TH AVE., SUITE D
Provider Second Line Business Practice Location Address:
WATER'S EDGE
Provider Business Practice Location Address City Name:
YAKIMA
Provider Business Practice Location Address State Name:
WA
Provider Business Practice Location Address Postal Code:
98902
Provider Business Practice Location Address Country Code:
US
Provider Business Practice Location Address Telephone Number:
509-574-3805
Provider Business Practice Location Address Fax Number:
509-574-3806
Provider Enumeration Date:
05/16/2006